| NPI | 1235687039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: DC HHA12175) |
| Additional Taxonomies | 3747P1801X Technician Personal Care Attendant |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2023-10-05 |